HomeMy WebLinkAboutWELL-11-2022-185200.TIF r
CATAWBA COUNTY Case# WELL-11-2022-185200
(IN
. Public Health Department Subdivision
y Environmental Health Division Subd 372109061111
PO Box 389,25 Government Drive,Newton,NC 28(58 LOT#
/8.2 w
Site Address: 1990 STARTOWN RD, HICKORY NC 28602
Name on Permit: ROB FOSTER
Property Size: Acres 0.48
Directions: Startown Rd, lot on the right before short rd
Owner/Authorized Representative Acknowledgement of Permit Receipt
I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
X.
As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service EHPR-11-2022-42808,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
7 Electronic Image Transmittal/E-mail (Return receipt required)
As the property owner or authorized representative I have reviewed and understand the specific conditions
of the permit issued, and further understand that all applicable regulatory requirements specified under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(15A NCAC 18A.1900),
and/or Well Construction Standards(15A NCAC 2C.0100), shall apply to the issuance of this permit and
the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date: 11/29/2022
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature '' Date/Time 1I N))
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpennit 11/29/2022 09:08V